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Nursing strategy responds to staffing concerns

Concerns about staffing and organisational culture were the biggest issues raised by nurses in response to the consultation on the chief nursing officers’ strategy for the profession, one of the authors of the document has told Nursing Times.

Compassion in practice was published by England’s two top nurses, Jane Cummings and Viv Bennett Hospital, last week following an eight week consultation with nurses around the country.

Professor Juliet Beal, who works alongside chief nursing officer Ms Cummings at the NHS Commissioning Board, told Nursing Times staffing levels and the “absolute, fundamental importance” of culture were highlighted most frequently by the 9,000 respondents.

“There are clearly areas [around the country] where there are not appropriate staffing levels on particular wards… Nurses and midwives absolutely recognise their own accountability… but they said one of the most important levers was to have a culture that enabled them to deliver that care,” she said.

Based around the “6Cs” that Ms Cummings and Ms Bennett believe should underpin nursing - care, compassion, courage, communication, commitment and competence – the strategy also proposes a number of actions.

It recommends boards publish staffing levels “at least every six months” and that all ward managers and team leaders be made supervisory to “give them time to lead”.

Professor Beal said she wanted to “steer clear of ratios”, such as registered nurse to occupied bed, which can mask understaffing at ward level.

Instead boards will be asked to declare publicly they have reviewed staffing levels across the organisation and assured themselves they can be confident of delivering care that will give good outcomes and patient experience.

Professor Beal, who is director of nursing for quality improvement and care at the commissioning board, has ten years experience as a director of nursing in an acute hospital.

She said the evidence around supervisory status for nursing mangers was clear but this meant a “senior leader out on the wards” not “sitting in an office”.

Although the strategy has been largely welcomed by senior nursing figures some have questioned what power they have to implement it.

Professor Beal told nursing times while the power of professional backing for the strategy “should not be underestimated” there were “hard levers” as well.

Commissioners will be encouraged to insist on supervisory nursing managers in contracts with hospitals and other providers of NHS care. In future the requirement to publish staffing levels could be written into the national contract for all NHS organisations.

A detailed implementation plan will be drawn up over the next few months and Ms Cummings and Ms Bennett have promised to report on what progress has been made by the end of February.

Speaking at the conference last week, Ms Cummings said: “We thought it would be a really good opportunity to do a stocktake on where we are at the end of February, in terms of how we move this on. That’s setting a challenge for me and the rest of the team around actually being able to report back on what we’ve done.”

Em Wilkinson-Brice, director of nursing at the Royal Devon and Exeter Foundation Trust, described the strategy as a “call to arms for us to start emotionally investing in some of our nurses”.

“How do you ensure you refresh and regularly lift people to be able to give compassionate care. That’s a really big challenge for us,” she told delegates during a panel debate.

Suzie Loader, director of nursing at Northampton General NHS Trust, added: “We need to recruit people for their values and behaviours as well as their clinical skills.”

Readers' comments
(16)

too many managers have been hiding away for too many years in offices, come out come out wherever you are and work with your team and then you might have a clue what's going on. They have been paid an exorbitant amount of money for loafing about and attending endless meetings.

Get rid of the lazy shiny arses who don't even know what a patient looks like anymore.

publishing staffing figures means nothing, members of the board are not the people caring for patients so they cannot assure anyone that safe care will be delivered.

many ward level managers have already decided to make themselves supernumerary, they sit in the office the entire shift only to appear when a consultant or hospital manager appears. what is a 'supervisory' manager - none of my managers supervise anything or anyone.

Jane Cummings Report “Compassion in Practice” has so far been a disaster for nurses. It has resulted in some of the worst media coverage ever over the past week. She has given the press a stick to beat nurses by suggesting that nurses are lacking in care in compassion. I would suggest that Jane Cummings would fail her own five”Cs”. Certainly her communication has been a disaster. The RCN had to appear on Radio 4 on the day of her pronouncement and face very hostile questions. To their credit they did concentrate on lack of adequate staffing as being of utmost importance. In the same week as Ms Cummings made her speech the NHS watchdog, Dr Foster, released a report saying that hospitals were full to bursting point and staff were rushed of their feet. How can staff provide adequate care and compassion in such circumstances? Jane Cummings failed to mention this report in her speech, I wonder why? I would suggest that she and the government do not want to draw attention to the real causes of poor care and it much easier to scapegoat and demonise nurses. This is similar to the way they are demonising the poor and unemployed as being workshy and feckless,” lying in bed with their curtains closed whilst other people go to work”. So we now get the feckless, lazy, uncaring and un-compassionate nurses as being the cause of all the ills in the health service. I would urge Jane Cummings to read some of the reports below, although I would have thought she should have been aware of them already. It seems she has chosen to ignore them and concentrate to her simplistic five C formula. Much easier that looking at the real causes and no doubt much more acceptable to her masters in government.“Hospitals are 'full to bursting' and patient care is being put at risk, report warns”Hospitals are 'full to bursting' and patient care is being put at risk, report warns. Dr Foster, the NHS watchdog, found 12 trusts have 'worryingly high' death rates for 48 weeks of the year most hospitals are more than 90 per cent full, 'jeopardising patient care'. A third of beds are taken by patients who could be cared for elsewhere. He added: “With bed occupancy of 95 per cent to 100 per cent for much of the year for many of the hospitals, there are too often no beds available, staff are rushed off their feet, patients are not cared for properly, infection rates rise and mistakes occur.”“Hospitals on the edge? The time for action”A potential crisis in hospital care is widely reported in the media today, with BBC News reporting that standards of hospital care are slipping throughout England. The Daily Mail states that elderly patients are being shunted between beds “like parcels”.The headlines are based on a new report by the Royal College of Physicians (RCP) of London, which warns that acute hospital care is under pressure, leading to “unnecessary pain, indignity and distress”. Many stories lead with the frightening claim that NHS hospitals could be on the brink of “collapse” – a term that the RCP’s report does not use, but which is present in its accompanying press release.The title of the report is Hospitals on the edge? The time for action“NHS Choices-Thursday September 13 2012” “Short-staffing nurses leads to care not being done “ October/December 2006 -- When nurses are short-staffed, a research study:"Missed Nursing Care: A Qualitative Study"found that much of necessary patient care was just not being done. Beatrice Kalisch, Past-President of the Center, published her findings in theJournal of Nursing Care Quality. The qualitative, focus group study of RNs, LPNs and nursing assistants found that care was being missed in 9 major areas including surveillance, discharge planning, patient teaching, ambulation, turning, feedings, emotional support, hygiene and intake and output documentation. One RN in the study stated: "People want to give good care and it bothers all of us when we can't do it. You are pulled in 10 directions, and you can't give quality care to your patients. It really bothers me.” And another said: “We don't let ourselves think about [the care not being done]. It is the way we cope. Underneath we don't feel good about it

“Adequately staffed nurses with good administrative support and good relations with physicians have more satisfied patients”February 2004 -- Patients were more than twice as likely to report high satisfaction with their care and nurses reported less burnout when nurses worked in conditions with adequate staff, good administrative support for nursing care, and good relations between themselves and physicians. It was a study of 820 nurses and 621 patients from 40 units in 20 US urban hospitals. See: Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. (2004). Nurse burnout and patient satisfaction.Medical Care2004; 42(2):II-57-II-66.

I suspect that 'cultural issues' would figure even more prominently, if patients & relatives had been asked instead of nurses - and also that slightly different 'cultural issues' might have been raised.

I'm pleased that this has highlighted 'lack of staff' - not so sure how it will result in more staff, though !

Blah blah blah heard it all before. Patients relatives and carer's will not get the levels of care they expect and deserve, until the chief nurse, trust CEO's and heads of finance accept that caring for the sick and vulnerable is labour intesive. and not just a process of pushing them through the sausage factory the NHS has become. 6C's will not be acheived until the appropriate level of properly trainied and supported staff are consistently available as a priority, they all know this is what's needed but non of them seem to be able to find an affordable and workable solution. Maybe its time to accept that we are not prepared to pay for the 'gold standard' and have to settle for adequate care.

I am hoping that this is a 6 monthly publication of the actual shift averages not based as so many have been on a single day audit or period of up to a fortnight as I have experienced in so many organisations for skill mix reviews. The "management" typically chose times when there was full nursing staffing and few medical staff around, like the summer holidays where surgery was in a lull due to consultant absence at far higher levels than wold ever be allowed in nursing.

It is essential that we have real time business intelligence of both patients and staff which can only be achieved with better use of IT in the NHS. Many of the systems in use in the NHS could provide this if only the organisational change had been delivered operationally. Sadly the Modernisation Agency and its various work streams were disbanded just at the time they were starting to deliver real change. The NHS management need to be fully accountable as clinicians are with professional registration and an EFFECTIVE body to control the ability to practice in the NHS. Until managers are judged on things other than the balance sheet, that is all they will consider. It is inequitable that clinical staff are given all the responsibility for delivering excellent care with little or no control over resources.

When these individuals remove themselves from their ivory towers and work on the wards, not for an hour or a day,but cover at least a months rota ,earlys ,lates and nights , they may then be in better a position to pass judgement and their views may be a little more respected.

How about a 'compassionate off duty' not one where staff work 10 shifts in a row which is more like an endurance test. How about ensuring staff have proper breaks and also some sustenance rather than having to work seven a half hours without a meal break, and somewhere to go where they can get a hot meal. If management tried to look after their staff maybe we wouldn't get burnt out so quickly.

Having worked shifts for past 25 years and now on secondment for 6 months working in the community on a 9-5 i can honestly say i don't know how i've survived it. When my wearyward based colleagues ask me how i'm finding it i reply 'luxury'.

If i have to go back on the wards after this secondment then i will seriously have to consider giving up nursing and getting another job because i cannot go back to that endurance test again. The quality of my life has improved so much in the past 2 months since leaving that treadmill. I'm feeling almost human again.

I'm pleased that life in the community is suiting you and, I assume, giving your worlf-weary body a chance to recover a bit.

As someone has pointed out, the problem with this type of thing is that managers tend to control both the measurement of the numbers and the presentation of the results. The measuring tends to be biased towards collecting 'good numbers' and the presentation tends to be done in such a way as to minimise the 'bad numbers'. In essence, if managers are 'marking themselves', the results are always questionable - especially those presented by stressed organisations.

Some staffs are fed up not only because of inadequate staffing (poor skill mix) but the following

Morals are low Bullying tactics from managementDiscrimination/unfairnessClicks within the team (yes some ward managers are part of it and encourages this behavior)No clear leadership (ward manager are sitting in the office only to be seen in Costa coffee)

I say bring back the EN’s who were accountable for their practices, were the backbone of basic nursing care, and where patients were fed, attended to pressure area by doing regular back round etc. And assist RGN’s to care for patients, and allowed ward managers (who incidentally knew all their patients) to lead the ward.

I dont know of any sister/charge nurse (a term not used much nowadays I know usually ward manger ? to shift the blame!) in the trust/directorate I work in who is not part of the numbers as the wards are as the reports say, 90% occupied and nowadays with highly dependent & technologically dependent patients. Many try to factor an office day but that often goes by the board when the ward is busy. However, even a day would not be enough what with the ever extending list of mandatory training (some to gain money for the trust but no actual advantage to the patient), erostering and the never ending form filling they have to do.We need to differenciate between WARD MANAGERS and MANAGER. The former being the 'sister/charge nurse' of the past and the latter a person who is usually not a nurse & holds the purse strings.There are rights and wrongs, good and bad on all side but as nurses I dont feel that we are generally valued for our skills & knowledge (yes maybe by the odd idividual in the team), our opinion is not sought and always the book stops with the nurse when there is a problem or something goes wrong. With this in mind, I think that nurses have gone into self preservation mode just to get thought the shift sane.We really do need to start to stand up for our selves and our profession, we need strong leaders that stand together so that we cannot be divided. Dont senior managers realise that if they got us on board right at the start we could actually help with achieving the organisations goals and maybe get ahead of the game?Realistically though, I see more and more disillutioned staff who are just going throught the motions and I find that heartbreaking.

I can safely say that if i ever had to work on a ward again i'd leave the profession in a heartbeat.

The problem with the NHS is the govt can't afford to run it properly. We konw that and they know that. It is also an organisation that wastes millions through incompetent management and govt policies (that's just a small amount though in reality).

It will become a 2nd rate organisation very soon. Many would argue it already is. It is being systematicaly broken up and sold off at the same time. A change of govt at the next election will see more money pumped back into it but much of the damage won't be fixable.

Nurses if they've any sense will leave and look for alternative work or even work abroad where they will be appreciated more.

Same here. If they send me back to the wards after my community secondment i shall be looking for another job before i collapse.

My body has served me well on the wards over many, many years of shift work and i am gobsmacked that i have survived physically and emotionally but i will not go back willingly and will hand in my notice in a heartbeat.

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